The congressional appropriations process is shaping up to be the next battleground over gender-affirming care, Axios' Maya Goldman writes.

Driving the news: Taxpayer funding of hormone therapies and gender-affirming surgeries would be barred under House Republicans' fiscal 2024 spending bill covering the federal health department, which is moving through Congress.

• If the policy is retained, Medicare and TRICARE could not cover gender-affirming care, and states choosing to cover services through Medicaid could not use federal funds to do so.
• Medicare currently covers gender affirming surgery on a case-by-case basis if it's considered medically necessary. TRICARE, the insurance for military personnel and their families, covers hormone therapy for gender dysphoria.

Zoom out: The proposed funding ban — which is tucked into the end of a 198-page spending bill — follows other efforts in the Republican-controlled House of Representatives to limit care for transgender individuals.

• The sweeping defense policy bill that the House passed on Friday also prohibits TRICARE from paying for gender-affirming surgeries and hormone therapies.
• The GOP has also advanced legislation to keep children's hospitals that offer gender-affirming surgery and hormones to minors from receiving federal funds to train pediatric residents and fellows.

Between the lines: Adding a funding restriction into a federal spending bill can have long-lasting implications, as seen during the decades-long battles over issues like abortion and gun violence.

• Federal spending restrictions on gender-affirming care are unlikely to pass muster with the Democratic-controlled Senate or be signed into law by President Biden.
• But the House provision could still be a flashpoint in negotiations on a final spending package.

Go deeper.

Rising demand for behavioral care and Medicare outpatient procedures are squeezing some of UnitedHealth Group's business segments but didn't stop the industry giant from beating Wall Street's expectations and posting earnings of $5.47 billion in Q2.

Why it matters: The parent of the biggest U.S. health insurer is a bellwether for broad industry trends. Despite higher-than-expected utilization and concern about how that could drive up health costs, the increases were less than feared, Reuters reported.

• United on Friday reported earnings of $5.47 billion, or $5.82 a share, up from $5.07 billion, or $5.34 a share, a year ago.

What they're saying: "Outpatient care activity among seniors was a few hundred basis points above our expectations," said John Rex, UnitedHealth's chief financial officer.

• That was driven by outpatient surgeries, especially orthopedic and cardiac procedures that may have been postponed during the pandemic.
• More Americans are also seeking behavioral care for anxiety, depression and substance use, reflecting an increasing ease seeking help, executives said.

What to watch: How much premiums go up next year, particularly in the Medicare Advantage market.

Go deeper: America's therapy boom

Meta's Threads may be an undeniable hit, but it's still a long way from unseating Twitter as a public square for the medical community.

• While many doctors active on Twitter have set up accounts on Threads, MedPage Today reports their Twitter use was increasing daily heading into the end of last week.

What's happening: Threads' shortage of features is a likely barrier, with new physician users unable to tap search functions to find their colleagues.

• And trolls and anti-science sentiment have already found a place on the new platform, alienating some users.

What they're saying: "It's hard to build a community that truly influences health care policy or changes individual behaviors from scratch," Katelyn Jetelina of the "Your Local Epidemiologist" newsletter on Substack told MedPage Today.

What we're watching: Whether Threads can prompt real-time dialogue on breaking news or develop some other kind of defining trait.

Cancer detection company Grail is facing legal challenges from three former employees, alleging gender and racial discrimination amid a "frat house" work culture.

Driving the news: In one of the lawsuits first reported by the Financial Times, a former associate director of product marketing alleged she was groped by a senior male executive at a company party. She also said the executive and another male employee drank beer throughout a work meeting in which she was pitching to be promoted that same day, FT reported.

• Another lawsuit from one of the women, who was director of Grail's national accounts, alleged that the same male executive, who has since left the company, as well as a female executive, created a "sexually charged work environment," FT writes.
• Both women said they were denied promotions and raises after expressing concerns.
• A third employee alleged in another lawsuit the company did not adequately respond to racist comments an employee made at a public sales event. She also said she was fired when she retained legal counsel as she sought to address the hostile work environment, FT writes.
• "Grail is committed to robust and fair employee practices that create a thriving, high-performing, productive, diverse, inclusive, and engaged workforce, and our workplace policies prohibit unlawful discrimination or retaliation," a spokesperson from Grail said in an email. "We will vigorously defend against these allegations."

Catch up quick: Regulators are still challenging the $8 billion acquisition of Grail by its former parent company, DNA sequencing giant Illumina, over antitrust concerns. Illumina was also recently slapped with a record $476 million fine from European regulators over the merger.

Medicaid could have saved upwards of $41 billion if every state had begun removing ineligible enrollees from program rolls when they were first able to in April, according to a report released today from the Paragon Health Institute.

Why it matters: The report from the think tank launched by ex-Trump economic adviser Brian Blase comes as the Biden administration cranks up pressure on states to forestall disenrollments amid concerns that patients still eligible for benefits are being dropped.

• As of July 14, roughly 2.2 million Medicaid enrollees have been disenrolled, based on data from 30 states and the District of Columbia compiled KFF's Medicaid Enrollment and Unwinding Tracker. More than 75% were disenrolled for procedural reasons, like not completing renewal forms.

Catch up quick: Pandemic-era protections that required continuous enrollment in Medicaid ended in April. While some states immediately began redetermining the eligibility of patients and removing them, others have moved more slowly.

What they're saying: Paragon says delaying decisions "pulls resources away from other public priorities and primarily benefits health insurance companies that administer Medicaid."

• The report cites estimates that roughly 18 million people who were ineligible for Medicaid were enrolled in the program on April 1 at an annualized cost of roughly $81.7 billion.
• Medicaid could have saved $41 billion and states could save another $12 billion with prompt redeterminations if states started in April and completed them in six months, as opposed to starting them in July and taking 12 months, the report says.

🏛 Harvard Medical faces another lawsuit over stolen body parts. (Axios)

💰 They lost their legs. Doctors and health care giants profited. (New York Times)

👉 Investigation finds no fraud by Texas prison contractor that was paid despite cutting inmate therapy services. (Texas Tribune)